AB0310 CARDIOVASCULAR RISK STRATIFICATION IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: P. Pusineri, S. Cabrera-Villalba, G. Avila, E. Leiva, V. Valinotti, L. Roman, A. Pineda, I. Acosta-Colman, M. Martínez, P. DE Abreu Trigueros, O. Centurion
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Patients with Rheumatoid Arthritis show an increased mortality population due predominantly to cardiovascular complications, which represent up to 50% of deaths. There are CVR scales that include RA as an independent risk factor. Even with constantly revised and updated assessment tools such as Qrisk III and SCOREm, there is still a tendency to underestimate the cardiovascular risk evidenced by asymptomatic atherosclerosis on ultrasound of the carotid vessels in patients previously classified in intermediate or low risk strata. <h3>Objectives</h3> To determine the cardiovascular risk stratum in adult patients with rheumatoid arthritis to stratify them according to the 2008 Framingham Risk Score, ScoreM and Qrisk III scales and to identify those high-risk patients who developed carotid lesions in ultrasonographic studies. <h3>Methods</h3> Descriptive, prospective, cross-sectional study, in a Paraguayan cohort of patients with RA meeting ACR/EULAR2010 criteria. A standardized questionnaire according to the variables included in the Cardiovascular Risk project (PINV15-0346), from the National Sciences and Technology Council (CONACYT), physical examination was made, and carotid ultrasound evaluation by a trained specialist, to evaluate subclinical atherosclerosis. Subclinical atherosclerosis was defined as carotid intima-media thickness (CIMT) &gt;0,9mm and/or presence of carotid plaques. The 2008 Framingham score, QRisk III and modified mSCORE were used for CV risk stratification. Quantitative variables were presented as means and qualitative as frequencies. Chi square test was performed for comparisons between dichotomous variables and t Student for continuous, and p ≤ 0.05 for statistical significance. Kappa coefficient was performed between scales, interpreted as: ≤ 0 as no agreement and 0.01–0.20 as none to slight, 0.21–0.40 as fair, 0.41– 0.60 as moderate, 0.61–0.80 as substantial, and 0.81–1.00 as almost perfect agreement. All patients signed informed consent. <h3>Results</h3> 100 were included, 87% were women, with a mean age of 51±11.3 years and mean disease duration 130.9±102.64 month. 9 (9%), 13 (13%) and 5 (5%) were classified as high risk according to the QriskIII, Framingham 2008 and ScoreM scales respectively. 27.14% of patients had subclinical atherosclerosis, exceeding by 14% the high-risk patients according to the Framingham classification, while mSCORE and QriskIII underestimated cardiovascular risk in 22 and 18 individuals, respectively. The kappa coefficient for agreement of high-risk patients according to QRiskIII was 0.593 (moderate concordance) relative to Framingham 2008 while ScoreM had a Kappa coefficient of 0.401 (fair concordance) relative to Framingham 2008. <h3>Conclusion</h3> In contrast to the estimation scales frequently used in clinical practice, which have a tendency to underestimate the risk in patients with rheumatoid arthritis, these results show that the cardiovascular risk demonstrated through ultrasonography of the carotid vessels more effectively characterizes high-risk patients. <h3>References</h3> [1] Myasoedova E, Davis JM, Crowson CS, Gabriel SE. Epidemiology of rheumatoid arthritis: Rheumatoid arthritis and mortality. Curr Rheumatol Rep. 2010;12(5):379–85. [2] González-Gay MA, González-Juanatey C. Enfermedad cardiovascular en artritis reumatoide. Importancia y tratamiento clínico. Reumatol Clin. 2009;5(3):95–7. [3] Peters MJL, Symmons DPM, McCarey D, Dijkmans BAC, Nicola P, Kvien TK, et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis. 2010;69(2):325–31. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.